Applied Evidence

Anticipating the care adolescents will need

J Fam Pract. 2021 March;70(2):E1-E11 | 10.12788/jfp.0162

References

1. World Health Organization. Adolescent health. Accessed February 23, 2021. www.who.int/maternal_child_adolescent/adolescence/en/

2. Sawyer SM, Azzopardi PS, Wickremarathne D, et al. The age of adolescence. Lancet Child Adolesc Health. 2018;2:223-228.

3. Pathak PR, Chou A. Confidential care for adoloscents in the U.S. healthcare system. J Patient Cent Res Rev. 2019;6:46-50.

4. AMA Journal of Ethics. HEADSS: the “review of systems” for adolescents. Accessed February 23, 2021. https://journalofethics.ama-assn.org/article/headss-review-systems-adolescents/2005-03

5. Cohen E, MacKenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. J Adolesc Health. 1991;12:539-544.

6. Possibilities for Change. Rapid Adolescent Prevention Screening (RAAPS). Accessed February 23, 2021. www.possibilitiesforchange.com/raaps/

7. Elster AB, Kuznets NJ. AMA Guidelines for Adolescent Preventive Services (GAPS): Recommendations and Rationale. Williams & Wilkins; 1994.

8. AAP. Engaging patients and families - periodicity schedule. Accessed February 23, 2021. www.aap.org/en-us/professional-resources/practice-support/Pages/PeriodicitySchedule.aspx

9. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Eng J Med. 2018;379:2468-2475.

10. Schuster MA, Franke TM, Bastian AM, et al. Firearm storage patterns in US homes with children. Am J Public Health. 2000;90:588-594.

11. Mokdad AH, Marks JS, Stroup DF, et al. Actual causes of death in the United States. JAMA. 2004;291:1238-1245.

12. HHS. Health consequences of smoking, surgeon general fact sheet. Accessed February 23, 2021. www.hhs.gov/surgeongeneral/reports-and-publications/tobacco/consequences-smoking-factsheet/index.html

13. Johnston LD, Miech RA, O’Malley PM, et al. Monitoring the future: national survey results on drug use, 1975-2017. The University of Michigan. 2018. Accessed February 23, 2021. https://eric.ed.gov/?id=ED589762

14. US Preventive Services Task Force. Prevention and cessation of tobacco use in children and adolescents: primary care interventions. Accessed February 23, 2021. www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-and-nicotine-use-prevention-in-children-and-adolescents-primary-care-interventions

15. HHS. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: HHS, CDC, NCCDPHP, OSH; 2012. Accessed February 23, 2021. www.ncbi.nlm.nih.gov/books/NBK99237/

16. NIH. Alcohol screening and brief intervention for youth: a pocket guide. Accessed February 23, 2021. https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuidePocket.pdf

17. Gorey C, Kuhns L, Smaragdi E, et al. Age-related differences in the impact of cannabis use on the brain and cognition: a systematic review. Eur Arch Psychiatry Clin Neurosci. 2019;269:37-58.

18. Secades-Villa R, Garcia-Rodriguez O, Jin CJ, et al. Probability and predictors of the cannabis gateway effect: a national study. Int J Drug Policy. 2015;26:135-142.

19. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance—United States, 2017. MMWR Surveill Summ. 2018;67:1-114.

20. NIH. Drug overdoses in youth. How do drug overdoses happen?. Accessed February 23, 2021. https://teens.drugabuse.gov/drug-facts/drug-overdoses-youth

21. Branstetter SA, Low S, Furman W. The influence of parents and friends on adolescent substance use: a multidimensional approach. J Subst Use. 2011;162:150-160.

22. AAP. Committee on Substance Use and Prevention. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138:e20161210.

23. Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1-8.

24. Halfon N, Larson K, Slusser W. Associations between obesity and comorbid mental health, developmental and physical health conditions in a nationally representative sample of US children aged 10 to 17. Acad Pediatr. 2013;13:6-13.

25. Griffiths LJ, Parsons TJ, Hill AJ. Self-esteem and quality of life in obese children and adolescents: a systematic review. Int J Pediatr Obes. 2010;5:282-304.

26. National Physical Activity Plan Alliance. The 2018 United States report card on physical activity for children and youth. Accessed February 23, 2021. http://physicalactivityplan.org/projects/PA/2018/2018%20US%20Report%20Card%20Full%20Version_WEB.PDF?pdf=page-link

27. HHS. NIMH. Child and adolescent mental health. Accessed February 23, 2021. www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/index.shtml

28. Yonek JC, Jordan N, Dunlop D, et al. Patient-centered medical home care for adolescents in need of mental health treatment. J Adolesc Health. 2018;63:172-180.

29. Brooks TL, Harris SK, Thrall JS, et al. Association of adolescent risk behaviors with mental health symptoms in high school students. |J Adolesc Health. 2002;31:240-246.

30. Weller BE, Blanford KL, Butler AM. Estimated prevalence of psychiatric comorbidities in US adolescents with depression by race/ethnicity, 2011-2012. J Adolesc Health. 2018;62:716-721.

31. Bilsen J. Suicide and youth: risk factors. Front Psychiatry. 2018;9:540.

32. Shain B, AAP Committee on Adolescence. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138:e20161420.

33. Brahmbhatt K, Hilty DM, Hah M, et al. Diagnosis and treatment of attention deficit hyperactivity disorder during adolescence in the primary care setting: review and future directions. J Adolesc Health. 2016;59:135-143.

34. Bravender T. Attention-deficit/hyperactivity disorder and disordered eating. [editorial] J Adolesc Health. 2017;61:125-126.

35. Rosen DS, AAP Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126:1240-1253.

36. Susman EJ, Houts RM, Steinberg L, et al. Longitudinal development of secondary sexual characteristics in girls and boys between ages 9 ½ and 15 ½ years. Arch Pediatr Adolesc Med. 2010;164:166-173.

37. Kaplowitz PB. Link between body fat and the timing of puberty. Pediatrics. 2008;121(suppl 3):S208-S217.

38. Ge X, Conger RD, Elder GH. Coming of age too early: pubertal influences on girl’s vulnerability to psychologic distress. Child Dev. 1996;67:3386-3400.

39. Jørgensen M, Keiding N, Skakkebaek NE. Estimation of spermarche from longitudinal spermaturia data. Biometrics. 1991;47:177-193.

40. Kar SK, Choudhury A, Singh AP. Understanding normal development of adolescent sexuality: a bumpy ride. J Hum Reprod Sci. 2015;8:70-74.

41. Susman EJ, Dorn LD, Schiefelbein VL. Puberty, sexuality and health. In: Lerner MA, Easterbrooks MA, Mistry J (eds). Comprehensive Handbook of Psychology. Wiley; 2003.

42. Lindberg LD, Santelli JS, Desai S. Changing patterns of contraceptive use and the decline in rates of pregnancy and birth among U.S. adolescents, 2007-2014. J Adolesc Health. 2018;63:253-256.

43. Guttmacher Institute. Teen pregnancy. www.guttmacher.org/united-states/teens/teen-pregnancy. Accessed February 23, 2021.

44. CDC. Social determinants and eliminating disparities in teen pregnancy. Accessed February 23, 2021. www.cdc.gov/teenpregnancy/about/social-determinants-disparities-teen-pregnancy.htm

45. Widman L, Nesi J, Kamke K, et al. Technology-based interventions to reduce sexually transmitted infection and unintended pregnancy among youth. J Adolesc Health. 2018;62:651-660.

46. Secura GM, Allsworth JE, Madden T, et al. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception. Am J Obstet Gynecol. 2010;203:115.e1-115.e7.

47. Ham P, Allen C. Adolescent health screening and counseling. Am Fam Physician. 2012;86:1109-1116.

48. ACOG. Committee on Adolescent Health Care. Adolescent pregnancy, contraception and sexual activity. 2017. Accessed February 23, 2021. www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/adolescent-pregnancy-contraception-and-sexual-activity

49. Wangu Z, Burstein GR. Adolescent sexuality: updates to the sexually transmitted infection guidelines. Pediatr Clin N Am. 2017;64:389-411.

50. Holway GV, Hernandez SM. Oral sex and condom use in a U.S. national sample of adolescents and young adults. J Adolesc Health. 2018;62:402-410.

51. CDC. STDs in adults and adolescents. Accessed February 23, 2021. www.cdc.gov/std/stats17/adolescents.htm

52. McClung N, Gargano J, Bennett N, et al. Trends in human papillomavirus vaccine types 16 and 18 in cervical precancers, 2008-2014. Accessed February 23, 2021. https://cebp.aacrjournals.org/content/28/3/602

53. Timbang MR, Sim MW, Bewley AF, et al. HPV-related oropharyngeal cancer: a review on burden of the disease and opportunities for prevention and early detection. Hum Vaccin Immunother. 2019;15:1920-1928.

54. Carey AJ, Beagley KW. Chlamydia trachomatis, a hidden epidemic: effects on female reproduction and options for treatment. Am J Reprod Immunol. 2010;63:576-586.

55. USPSTF. Chlamydia and gonorrhea screening. Accessed February 23, 2021. www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chlamydia-and-gonorrhea-screening

56. Workowski KA, Bolan GA. Sexually transmitted diseases treatment guidelines, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1-135.

57. CDC. Sexually transmitted disease surveillance 2018. Accessed February 23, 2021. www.cdc.gov/std/stats18/gonorrhea.htm

58. SAHM. HIV pre-exposure prophylaxis medication for adolescents and young adults: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health. 2018;63:513-516.

59. Kann L, McManus T, Harris WA, et al. Youth risk behavior surveillance–United States, 2015. MMWR Surveill Summ. 2016;65:1-174.

60. CDC. LGBT youth. Accessed February 23, 2021. www.cdc.gov/lgbthealth/youth.htm

61. Johns MM, Lowry R, Rasberry CN, et al. Violence victimization, substance use, and suicide risk among sexual minority high school students – United States, 2015-2017. MMWR Morb Mortal Wkly Rep. 2018;67:1211-1215.

62. Pew Research Center. Teens, social media & technology 2018. . Accessed February 23, 2021. www.pewinternet.org/2018/05/31/teens-social-media-technology-2018/

63. Chassiakos YLR, Radesky J, Christakis D, et al. Children and adolescents and digital media. Pediatrics. 2016;138:e20162593.

64. Arora T, Albahri A, Omar OM, et al. The prospective association between electronic device use before bedtime and academic attainment in adolescents. J Adolesc Health. 2018;63:451-458.

65. Mishna F, Saini M, Solomon S. Ongoing and online: children and youth’s perceptions of cyber bullying. Child Youth Serv Rev. 2009;31:1222-1228.

66. Sengupta A, Chaudhuri A. Are social networking sites a source of online harassment for teens? Evidence from survey data. Child Youth Serv Rev. 2011;33:284-290.

Universal immunization of all children older than 11 years of age against HPV is strongly advised as part of routine well-child care. Emphasize the proven role of HPV vaccination in preventing cervical⁵² and oropharyngeal⁵³cancers. And be prepared to address concerns raised by parents in the context of vaccine safety and the initiation of sexual behaviors (www.cdc.gov/hpv/hcp/answering-questions.html).

Chlamydia is the second most common STI in the United States, usually occurring in individuals younger than 24.⁵⁴ The CDC estimates that more than 3 million new chlamydial infections occur yearly. These infections are often asymptomatic, particularly in females, but may cause urethritis, cervicitis, epididymitis, proctitis, or pelvic inflammatory disease. Indolent chlamydial infection is the leading cause of tubal infertility in women.⁵⁴ Routine annual screening for chlamydia is recommended for all sexually active females ≤ 25 years (and for older women with specific risks).⁵⁵ Annual screening is also recommended for men who have sex with men (MSM).⁵⁵

Chlamydial infection may be diagnosed with first-catch urine sampling (men or women), urethral swab (men), endocervical swab (women), or self-collected vaginal swab. Nucleic acid amplification testing is the most sensitive test that is widely available.⁵⁶ First-line treatment includes either azithromycin (1 g orally, single dose) or doxycycline (100 mg orally, twice daily for 7 days).⁵⁶

Gonorrhea. In 2018, there were more than 500,000 annual cases of gonorrhea, with the majority occurring in those between 15 and 24 years of age.⁵⁷ Gonorrhea may increase rates of HIV infection transmission up to 5-fold.⁵⁷ As more adolescents practice oral sex, cases of pharyngeal gonorrhea (and oropharyngeal HPV) have increased. Symptoms of urethritis occur more frequently in men. Screening is recommended for all sexually active women younger than 25.⁵⁶ Importantly, the organism Neisseria gonorrhoeae has developed significant antibiotic resistance over the past decade. The CDC currently recommends dual therapy for the treatment of gonorrhea using 250 mg of intramuscular ceftriaxone and 1 g of oral azithromycin.⁵⁶

Syphilis. Rates of syphilis are increasing among individuals ages 15 to 24.⁵¹ Screening is particularly recommended for MSM and individuals infected with HIV. Benzathine penicillin G, 50,000 U/kg IM, remains the treatment of choice.⁵⁶

Continue to: HIV